Page 689 - Clinical Application of Mechanical Ventilation

Case Studies 655

chest radiographs, subcutaneous emphysema, and ultimately death. Many of
these complications could have been expected as a result of her hospital course,
because ARDS, even without her related complicating factors, carries a 50%
mortality rate.
Data from a “low tidal volume” clinical trial showed approximately 25% fewer
deaths among patients receiving small, rather than large, tidal volumes during me-
chanical ventilation. Medical centers have generally adopted this strategy as an
evidence-based standard of practice for ARDS. Patient tidal volume is based on the
ideal body weight calculation. This is calculated from the following equation:

Male: 50 1 2.3 (Height in Inches 2 60) 3 6 mL
Female: 45.5 1 2.3 (Height in Inches 2 60) 3 6 mL

Although the patient in this case study was not on this protocol, it seems worth
mentioning that these guidelines have been proven to be useful in the management
of ARDS. This is particularly true with the ARDSnet protocol for the treatment of
acute lung injury (ALI) from any cause.

References (HFO and ARDS):
Derdak, S., Mehta, S., Stewart, T. E., Smith, T., Rogers, M., Buchman, T. G., . . .
the Multicenter Oscillatory Ventilation for Acute Respiratory Distress Syndrome
Trial (MOAT) Study Investigators. (2002). High-frequency oscillatory ventila-
tion for acute respiratory distress syndrome in adults: A randomized, controlled
trial. American Journal of Critical Care Medicine, 166(6), 801–808.
Derdak, S., Mehta, S., Stewart, T. E., Smith, T., Rogers, M., Buchman, T. G., Car-
lin, B., Lowson, S., Granton, J., and the Multicenter Oscillatory Ventilation for
Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators. (2003).
High-frequency oscillatory ventilation for acute respiratory distress syndrome in
adult patients. Critical Care Medicine, 31(4 Suppl.), p. s317–323.
Downar, J., & Mehta, S. (2006). Bench-to bedside review: High-frequency oscillatory
ventilation in adults with acute respiratory distress syndrome. Critical Care, 10, 240.
Fan, E., & Rubenfeld, G. D. (2010). High frequency oscillation in acute lung in-
jury and ARDS. British Journal of Medicine, 340, 2315.

References (suctioning and saline lavage):
Ackerman, M. H. (1993). The effect of saline lavage prior to suctioning, Journal of
Critical Care, 2(4), 326–330.
Pedersen, C. R. (2009). Endotracheal suctioning of the adult intubated patient -
what is the evidence? Intensive and Critical Care Nursing, 25(1), 21–30.

Reference (low tidal volume strategy):
The Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower
tidal volumes as compared with traditional tidal volumes for acute lung injury
and the acute respiratory distress syndrome. New England Journal of Medicine,
342, 1301–1308.

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